Leaderboard

I've been pretty much off the grid for the past month and thought I would check in. We're driving around Alaska enjoying retirement. Hope all you folks are holding down the fort. I'm sure you are doing a great job.

Sorry for the delay in replying. I am not receiving this newsletter in my email anymore for some reason. Yes we use Cerner. I don't think the baby and mom are linked. If they are, the lab can't see it on our side. We used to put the cord blood workup under the mom's number. That changed when the EMR came along to foul things up. Now the baby is ordered under their own medical record number. We have L/D wrap a mom's chart label sideways on the top of the cord blood and the baby label is placed up and down in the normal way. That way we have the mom's name and number when we are putting in the baby results. We look up the mom to make sure we have a current blood type. If current, we type the mom's type into the results. If it is not current, we get a new specimen. Blood Bank history is not always reliable. Unfortunately, the computer doesn't compare the baby type to the mom type, we have to do that. Talking about the history is not always reliable..... a patient came in to have a baby. The blood type didn't match the history. Had her collected again. It still didn't match her history. Started digging in the computer. Turns out, she had a baby 3 months earlier. (???) Called L/D to see if this was some type of weird OB case. No, it turns out the one that gave birth 3 months earlier had a Medicaid card and it worked so well when she gave birth that she loaned it to her friend. Just a little bit of fraud. Go figure. Never rely on computer history

I ordered a microwave from Ark Bio-Medical in 2016 and waited a year to receive one. It is true they have had a manufacturer of some of their parts go out of business and it has taken time to find another. They have found a new manufacturer and are in production, however now all the paperwork must be re-approved by the FDA and that is where the problem lies. They have complied with all FDA requests but are awaiting approval. In the mean time the distributor just installed one he had in stock for us and we love it! It works very well. We were instructed to make sure the sensor in the microwave was not placed on the side of the unit with a bubble. We are a small hospital and it has saved us over $3000 dollars a quarter in wasted plasma. Now we thaw on demand and it takes about 8-10 minutes to get a fairly large size unit ready. We still have the Helmer water bath plasma thawer for cryo and units that do not fit the carrier but the microwave is great in a trauma. We are also taking the temp of every unit we thaw upon completion at least for a while. I am an old blood banker and I was very skeptical at first but so far we love it!!

Yes, Indeed it will be more fun.

Great! You are such an adventurous and devoted person. Wish you best of luck for your next climb, and keep us updated with your pictures.

If I have no history I get an ABORh. I also prefer one if a new admission even if I have a history. It just helps to verify the patient. I am not averse to transfusing either based on a historical type in my file.

Better make certain you validate the heck out of Epic, esp if you are using Beaker. My most recent experience with Epic/Beaker and HCLL made me want to call the FDA. I'd run my own validation protocols rather than the Epic ones. Not enough training for staff , though this could have been a vagary of the institution rather than the system.

The AABB TM, 18th edition, states in Chapter 22, Perinatal Issues in Transfusion Practice, Serology and Mechanism, "Administration of RhIG during pregnancy may produce a positive antibody screening result in the mother, but the titer is rarely greater than 4 and thus poses no risk to the fetus." If we ID anti-D in prenatal sample, we perform a 1:4 dilution and if the results are non-reactive we have two statements in our report, "The antibody demonstrated a titer of less than 4 in saline at AGT indicating that it may be due to recent administration of RhIG." and "Due to the recent administration of RhIG, the antibody may have been passively acquired. To establish this as the sole cause of the antibody's presence, repeat testing six months post-delivery should demonstrate a negative antibody screen."

In uk if quantification level is 0.4 IU/mL or above we consider as a immune anti-D and we do not issue RhIg. However if lady comes in ED we perform Group and antibody screen before we issue RhIg.

Well, in a way, yes. They will not waste time on trying to perform alloadsorptions (as these don't work) and will probably perform genotyping from the word go, rather than trying to get a phenotype. To be honest, the submitting hospital should give the Reference Laboratory as much information as they can about ANY patient, whether they be on ANTI-CD38 (gagpinks, they are on a monoclonal antibody - not a monoclonal antigen!!!!!!!!!!!) or not.

We've been extremely happy with the Rad Source. Service and extended downtimes on the Raycell were an issue since parts had to make it through Customs from Canada. Rad Source offers 24/7 phone support, if needed. We have had minimal problems. They are based in Georgia, and respond quickly if there is a issue. There is also a syringe adapter for neo aliquots. I don't know anything about disposal of a cesium device, but Rad Source did take care of of Raycell.

I worked at a blood center for years and used the Raycell Mk2 (the 3.5L model, the larger model that can do up to 6 RBCs at once). It was a pain to install and maintain the water source to cool the system. During the colder months (in the Northeast US), the water source had to be bypassed because it was too cold. We had to keep tweaking the pump and the filter system until we found one that could handle our municipal water--amazing how much sediment is in it! The Mk2 was down a LOT, IMHO. It was not like Best Theratronics Cesium irradiator, which was almost NEVER down, but which nevertheless had to be replaced (a) because it could only do 1 RBC at a time, and (b) because of the onus of all the security and NRC regulations. Because it was down so much, and the blood center had to maintain a supply of irradiated blood/platelet products, we had to ask a local hospital to irradiate for us, sometimes for several days at a time. Having said that, I did hear that a nearby hospital was using the Mk2 2.0L model, the smaller one that can do up to 4 RBCs at once, and it was almost never down... You HAVE to consider that the X-ray tubes have to be replaced every 7 years or so, at a considerable expense. Best Theratronics is a Canadian company. Not that I have anything against our neighbor to the north, but the equipment was more than once held up by customs, and PM or repair was delayed, sometimes by several days. I am now at a hospital transfusion service (the one that I used to send the blood center's irradiation to during down-time!), and back to using the Cs-137 GammaCell 1000 irradiator. Because of all the security/NRC compliance issues, I would love to switch to an X-ray irradiator. In my research, I found the Rad Source RS-3400 quite appealing. The sales person at the company said that all PM & repairs--including the X-ray source replacement, are covered by the maintenance contract (15k/year). And this is an American company, so no customs delays! Carrie M., what has your experience been since you switched a year ago? Are you happy that you changed from the Raycell? Again, I would love to go away from the Cs irradiator, and I'd love to hear the comparison/contrast between the Raycell & the RS-3400 from someone who has experience with both.

I quite fancy an expedition to Loch Ness - with or without the monster......

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen. If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA, and internal auditors.

I have retired from active clinical laboratory - for what it is worth.

It does not say that . . . in fact I don't believe any regulatory agency requires Management to be competent in any area of the lab - as long as they do not perform any testing. If they test, they have to have a competency.